Medicare Part D

Why is Part D confusing?

In 2019 Medicare Part D premiums and covered medications will vary based on the plan you select. Some plans require a yearly deductible ($415) before coverage begins while others have a zero or a smaller deductible. Once you meet your yearly deductible then you start paying co-pays based on the Tier level for your medications.

Certain high-income clients with joint incomes starting at $85,000 to $170,000 will have an additional IRMAA Part D amount to pay in addition to the Part D premium.

Because everyone has different prescriptions and pharmacies no one plan can fit all. Each year your insurance company will mail you a new Formulary that lists all the medication and Tier levels that are covered in your policy. It is your yearly responsibility to review the Formulary and make sure your medications are covered.

Advantage plans in 2018 and 2019 will include Part D prescription coverage and some plans will offer health-only Advantage plans without Part D. If you have a Supplemental plan Part D is not included. You will need a stand-alone prescription Part D plan.

In 2019 all Part D pans have will have three phases of coverage; Initial, Coverage Gap and Catastrophic.

Initial Coverage is the amount you pay for each medication based on the Tier level, and after your yearly deductible is met. Once your pay more than $3,820 total out-of-pocket, then you move to the coverage gap.

Coverage Gap begins after your Initial Coverage amount exceeds $3,820. Then you will pay 37% for Generics and 25% for Brand name drugs until your combined out-of-pocket costs exceed $5,000.

Catastrophic Coverage begins after you pay more than $5,000 in the Coverage Gap. Then you will pay $3.33 for Generics and $8.35 for brand name drugs. You will remain at this pricing level until January 1st the following year.